JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. the Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 15, 2007)
TONSILLECTOMY ASSOCIATED WITH IMPROVED SLEEP AND BEHAVIOR IN CHILDREN WITH SLEEP-RELATED BREATHING DISORDERS
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 15, 2007)
LOSING WEIGHT BEFORE BARIATRIC SURGERY ASSOCIATED WITH SHORTER HOSPITAL STAY, FASTER POSTOPERATIVE WEIGHT LOSS
SOME OBESE PATIENTS MORE LIKELY TO RETURN TO WORK FOLLOWING GASTRIC BYPASS SURGERY
SUICIDE, CORONARY HEART DISEASE CONTRIBUTE TO INCREASED RISK OF DEATH FOLLOWING BARIATRIC SURGERY
EDITORIAL: RESEARCH NEEDED TO OVERCOME BARIATRIC SURGERY OBJECTIONS
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 15, 2007)
EDITORIAL: DERMATOLOGISTS ADVANCE SCIENCE OF WOUND HEALING, CARE
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access.
Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 15, 2007
Media Advisory: To contact Julie L. Wei, M.D., call Bob Hallinan at 913-588-5246.
TONSILLECTOMY ASSOCIATED WITH IMPROVED SLEEP AND BEHAVIOR IN CHILDREN WITH SLEEP-RELATED BREATHING DISORDERS
CHICAGO—Children diagnosed with sleep-disordered breathing appear to sleep better and have improved behavior following removal of their tonsils and adenoids, according to a report in the October issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Sleep-related breathing disorders include snoring, obstructive sleep apnea syndrome and other conditions affecting air flow, according to background information in the article. As many as 11 percent of children may develop these conditions. Sleep-disordered breathing in children has been associated with attention-deficit/hyperactivity disorder (ADHD), hyperactive behavior, academic problems, bedwetting, learning disabilities, sleepiness during the day, headaches and other complaints.
Julie L. Wei, M.D., of the University of Kansas School of Medicine, Kansas City, and colleagues studied 117 children (average age 6.5) who were diagnosed with sleep-disordered breathing and who underwent adenotonsillectomy (removal of the tonsils and adenoids, tissue at the back of the throat). Parents completed surveys about their children’s sleep and behavior before and six months after surgery.
Among the 71 children who completed the six-month follow-up, scores for sleep problems and behavioral difficulties were significantly lower after six months than before surgery. This included reductions in cognitive (thinking, learning and memory) problems, hyperactivity, oppositional behavior and ADHD symptoms.
The researchers also found correlations between sleep and behavior scores before and after surgery. "Not only did both behavior and sleep improve independently before and after adenotonsillectomy for sleep-disordered breathing in our group of patients, but they also improved in correlation with each other," the authors note.
(Arch Otolaryngol Head Neck Surg. 2007;133(10):974-979. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 15, 2007
Media Advisory: To contact Christopher D. Still, D.O., call Patti Urosevich at 570-271-7441.
LOSING WEIGHT BEFORE BARIATRIC SURGERY ASSOCIATED WITH SHORTER HOSPITAL STAY, FASTER POSTOPERATIVE WEIGHT LOSS
CHICAGO—High-risk morbidly obese patients who lose 5 to 10 percent of their excess body weight before undergoing gastric bypass surgery appear to have shorter hospital stays and more rapid postoperative weight loss, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
Bariatric surgery is an effective long-term treatment for morbidly obese patients with co-occurring medical problems, according to background information in the article. "To that end, older and higher-risk patients with multiple uncontrolled medical problems (such as diabetes mellitus, obstructive sleep apnea, steatohepatitis [liver inflammation], degenerate joint disease, venous stasis disease [loss of vein function in the legs] and cardiopulmonary vascular disease) are opting for bariatric surgery," the authors write. "Moreover, patients are seeking referral for bariatric surgery when the disease burden from their comorbidities eliminates meaningful quality of life." These patients may face more complications following surgery.
Christopher D. Still, D.O., and colleagues at Geisinger Health Care System, Danville, Penn., assessed patients who underwent open or laparoscopic gastric bypass surgery between 2002 and 2006. "Patients were required to participate in a standardized multidisciplinary preoperative program that encompasses medical, psychological, nutritional and surgical interventions and education," the authors write. "In addition, patients were encouraged to achieve a 10 percent loss of excess body weight prior to surgical intervention."
Of the 884 patients (average age 45), 169 (19 percent) lost 5 to 10 percent of their excess body weight prior to the operation and 425 (48 percent) lost 10 percent or more of excess weight prior to the operation. Those who lost more than 5 percent were less likely to stay in the hospital longer than four days, whereas those who lost more than 10 percent of their excess weight before surgery were more than twice as likely to have lost 70 percent of excess weight one year afterward, compared with those who lost between none and 5 percent of their excess pounds before surgery.
The authors speculate that physiologic improvements associated with weight loss decreased surgical complications, reducing the length of hospital stay. "Numerous reports have confirmed the beneficial effects of even limited weight loss on co-morbid medical conditions, such as hypertension [high blood pressure], diabetes mellitus, degree of visceral [among internal organs] fat, liver size, thromboembolism [blood clot] predisposition and severity of sleep apnea," the authors write. "Additional studies will be required to pinpoint which comorbidity (or comorbidities) is responsible for reduced lengths of stay."
In addition, further research is needed to determine how preoperative weight loss could help with long-term weight loss following surgery, they note.
(Arch Surg. 2007;142(10):994-998. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 15, 2007
Media Advisory: To contact corresponding Richard C. Thirlby, M.D., call Kim Davis at 206-583-6451.
SOME OBESE PATIENTS MORE LIKELY TO RETURN TO WORK FOLLOWING GASTRIC BYPASS SURGERY
CHICAGO—Obese Medicaid patients who undergo Roux-en-Y gastric bypass surgery may be more likely to return to work than obese Medicaid patients who do not undergo the surgery, according to a report in the October issue of Archives of Surgery, a theme issue on bariatric surgery.
About 65 percent of adults in the U.S. are overweight and 5 percent are morbidly obese, having a body mass index (BMI) greater than 40, according to background information in the article. "Obesity is associated with a variety of diseases, including diabetes mellitus, hypertension, hyperlipidemia, degenerative arthritis, sleep apnea and left ventricular hypertrophy. Depression, social isolation and discrimination further compound the disability associated with morbid obesity," the authors write. "As a result, morbid obesity results in dramatic increases in health care costs."
Amy J. Wagner, M.D., and colleagues at Virginia Mason Medical Center, Seattle, studied 38 medically disabled patients receiving Medicaid who between 1997 and 2002 underwent Roux-en-Y gastric bypass performed by a single surgeon and compared these patients with 16 patients receiving Medicaid who were seen by the same surgeon, but did not undergo surgery. Patients’ medical data were obtained by a review of their clinical charts and long-term follow-up telephone interviews.
Patients who underwent surgery had an average age of 48 and an average BMI of 58 before surgery and were followed for an average of 44 months, while those who did not undergo surgery had an average age of 51 and an average BMI of 54 at the beginning of the study and had an average of 32 months of follow-up. Average follow-up BMIs for the operative and non-operative groups were 36.2 and 52, respectively.
"The patients who underwent Roux-en-Y gastric bypass were more likely to return to work, with 14 (37 percent) working, compared with 1 (6 percent) of the non-operative control patients," the authors write. "Return to work was more likely in patients who had resolution of comorbid conditions [co-occurring illnesses] after surgery." Those who returned to work no longer required Medicaid funding.
"The practical implication of these findings is that the presence of reversible obesity-related comorbidities may be an appropriate prerequisite for approval of bariatric surgery in this population," the authors conclude. "Surgical treatment of morbid obesity has a profound effect on patients’ quality of life as evidenced by the sustained long-term weight loss, reversal of comorbidities, improved rating of quality of life and the patients’ ability to return to the workforce."
(Arch Surg. 2007;142(10):935-940. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 15, 2007
Media Advisory: To contact corresponding author Lewis H. Kuller, M.D., Dr.P.H., call Michele Baum at 412-647-3555.
SUICIDE, CORONARY HEART DISEASE CONTRIBUTE TO INCREASED RISK OF DEATH FOLLOWING BARIATRIC SURGERY
CHICAGO—Approximately 1 percent of Pennsylvania residents who underwent bariatric surgery between 1995 and 2004 died within one year of the surgery and nearly 6 percent died within five years, according to a report in the October issue of Archives of Surgery, a theme issue on bariatric surgery. Death rates overall, as well as deaths from heart disease and suicide, were higher than those of the general state population.
Bariatric surgery has emerged as an effective treatment for severe obesity, according to background information in the article. Obese individuals typically lose up to 80 percent of their excess body weight one to two years after the operation. “Bariatric surgery results in clinical improvement and resolution of the obesity-related comorbid diseases,” the authors write, including diabetes, high blood pressure and high cholesterol.
Bennet I. Omalu, M.D., M.P.H., of the University of Pittsburgh, and colleagues analyzed data on all bariatric operations performed on Pennsylvania residents between 1995 and 2004. Following 16,683 operations, 440 patients (2.6 percent) died.
“Age- and sex-specific death rates after bariatric surgery were substantially higher than comparable rates for the age- and sex-matched Pennsylvania population,” the authors write. “This continued high mortality rate is likely a function of the initial comorbidities related to substantial obesity and the likelihood that the patients remain obese even after the substantial weight loss and have remaining comorbidities.”
The researchers found that:
- Less than 1 percent of the deaths occurred within the first 30 days after surgery.
- The one-year case fatality rate was approximately 1 percent and at 5 years, the cumulative case fatality was 6.4 percent.
- Death rates increased with age, especially among patients older than 65; the average age at surgery was 48 years.
- Heart disease was the leading cause of death, cited for 76 patients (19.2 percent). Rates of death from heart disease were higher among bariatric surgery patients than the general population.
- Of 45 deaths from traumatic causes, 16 (4 percent of all deaths) were suicides and 14 (3 percent) were drug overdoses not classified as suicides. Based on national statistics for the general population, only two suicide deaths would have been expected among this number of individuals.
“It is likely that this continued excess mortality after bariatric surgery could be reduced by better coordination of follow-up after the surgery, especially control of high risk factors such as hypertension, diabetes mellitus, hyperlipidemia [high cholesterol] and smoking, as well as efforts to prevent weight regain by diet and exercise and psychological support to prevent and treat depression and suicide,” the authors conclude.
(Arch Surg. 2007;142(10):923-928. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 15, 2007
Media Advisory: For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email: mediarelations{at}jama-archives.org. To contact editorialist Edward H. Livingston, M.D., call Russell Rian at 214-648-3404.
EDITORIAL: RESEARCH NEEDED TO OVERCOME BARIATRIC SURGERY OBJECTIONS
Articles in Archives of Surgery theme issue begin to fill gap
CHICAGO—Bariatric surgery has become more acceptable, but additional research is needed to demonstrate to insurance companies and the public that it is the best long-term treatment for obesity, according to an editorial in the October issue of Archives of Surgery, one of the JAMA/Archives journals. The editorial, written by Edward H. Livingston, M.D., of the University of Texas Southwestern Medical Center, Dallas, is part of a theme issue on bariatric surgery.
"The studies presented in this issue of the Archives provide us with more knowledge about these procedures’ risks, outcomes, complication profiles, improved functionality associated with surgically induced weight loss, need for long-term monitoring and equivalency of the various laparoscopic banding operations," Dr. Livingston writes. "However, we will need more to convince the non-believers in bariatric surgery that it is the appropriate therapy for morbidly obese patients who have, or may develop, complications from their excessive weight."
Papers in the theme issue suggest that:
- Routine upper gastrointestinal (GI) studies—expensive tests typically performed following bariatric procedures—may not be necessary
- Current techniques for examining the upper GI in patients with abdominal symptoms can be modified to accommodate those who have had gastric bypass
- Anastomotic leaks at the surgical site can have devastating consequences and should be treated as early as possible
- About 4.4 percent of patients experience bowel obstructions after gastric bypass
Such ongoing research is necessary due to the lack of alternatives for obese patients, Dr. Livingston notes. "Nonsurgical weight loss efforts in the morbidly obese result in transient weight loss, if any at all," he writes. "There are no anti-obesity drugs in the pipeline that will be released soon, and even so, none of the medications in development appear to have major impact on morbid obesity. Thus, weight loss surgery is here to stay since it is the only treatment modality with proven success at inducing profound and sustained weight loss for the morbidly obese."
"This edition of the Archives goes a long way to addressing the critical issues facing this field," Dr. Livingston concludes.
(Arch Surg. 2007;142(10):919-922. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the October issue of Archives of Surgery for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 15, 2007
Media Advisory: For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email: mediarelations{at}jama-archives.org. To contact editorialist Robert S. Kirsner, M.D., Ph.D., call Lisa Worley at 305-243-5184.
EDITORIAL: DERMATOLOGISTS ADVANCE SCIENCE OF WOUND HEALING, CARE
Skin biopsies, leg ulcers highlighted in Archives of Dermatology wound healing theme issue
CHICAGO—Cosmetic, medical and surgical dermatologists all play a role in the treatment and management of wounds, according to an editorial in the October issue of Archives of Dermatology, one of the JAMA/Archives journals.
"Medical conditions as diverse as pemphigus vulgaris, primary syphilis, lupus erythematosus and sarcoidosis all either have or can have wounds as part of their initial presentation," writes editorialist Robert S. Kirsner, M.D., Ph.D., of the University of Miami. "Dermatologists create more wounds through surgical procedures and biopsies than any other specialty. Often, wounds are treated with surgical procedures such as debridement or grafting. Finally, with regard to cosmetic dermatology, its goals and the goals of wound healing are often the same: to fill a defect or contour, to provide dermal support and to normalize epithelialization [regrowth of tissue]."
The issue contains articles about a wide variety of wounds and aspects of their healing, including a laser system to assess wounds, aspects of leg ulcers that prevent them from healing and techniques that can make skin biopsies less prone to infection. "This issue allows the Archives to celebrate dermatology’s role in advancing the science of wound care," Dr. Kirsner writes. Because wounds are common and expensive to the American health care system, these advances will have wide benefits.
(Arch Dermatol. 2007;143(10):1318-1319. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
PATIENTS WITH LEG ULCERS HAVE LOW LEVELS OF EXERCISE AND COMPRESSION THERAPY
Many patients with venous leg ulcers—wounds in the lower legs caused by increased blood pressure in the veins—do not exercise or use compression therapy, two vital factors that can speed healing and prevent recurrence. Maud M. Heinen, Ph.D., R.N., of Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands, and colleagues interviewed 150 patients with venous leg ulcers about their exercise habits and their use of compression therapy, usually provided through elastic stockings or bandages. Participants also wore a physical activity monitor for a week before their interview. About 40 percent regularly used compression therapy. A total of 56 percent of the patients performed less than 2.5 hours of physical activity per week and 35 percent did not walk for 10 minutes at least once during the week. Also, only 35 percent performed the recommended leg exercises. "Patients should be educated and encouraged to (1) enhance physical activity through walking and leg exercises and (2) increase adherence to compression therapy," the authors conclude.
(Arch Dermatol. 2007;143(10):1283-1288. Available to the media pre-embargo at www.jamamedia.org).
MEDICATION APPEARS TO HAVE PROTECTIVE ASSOCIATION AGAINST LEG ULCERS
Use of drugs known as β-adrenergic receptor agents (agonists and perhaps antagonists) appear to be associated with reduced odds of venous leg ulcers. David J. Margolis, M.D., Ph.D., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues assessed 414,887 patients who visited a general practitioner in the United Kingdom between 1987 and 2002. Of these, 62,886 were prescribed β-adrenergic receptor agonists to treat or prevent a medical condition. An additional 54,861 took β-adrenergic receptor antagonists, which work along the same pathway but through a different mechanism, with 6,620 taking both. "A protective association between β-adrenergic receptor agonists and perhaps β-adrenergic receptor antagonists and venous leg ulcers exists," the authors write. "The evidence in this study should not be used as a rationale for treatment of venous leg ulcers with β-adrenergic receptor agents but should be compelling for the consideration of a randomized clinical trial."
(Arch Dermatol. 2007;143(10):1275-1280. Available to the media pre-embargo at www.jamamedia.org).
INJECTION DRUG USE ASSOCIATED WITH CHRONIC VEIN DISEASE
Users of heroin and other injection drugs commonly experience leg ulcers and other chronic vein diseases, according to a special article published in the issue. Barbara Pieper, Ph.D., A.P.R.N., B.C., C.W.O.C.N., of Wayne State University, Detroit, and colleagues outline ways in which administering drugs intravenously can harm veins, including scarring and collapse. This damage can continue to worsen even after an individual stops using drugs. "Chronic venous disease increases pain in the legs and decreases mobility, affecting one’s quality of life and activity involvement," the authors write. "Recognition of chronic venous disease as a complication of intravenous drug use is crucial."
(Arch Dermatol. 2007;143(10):1305-1309. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the October issue of Archives of Dermatology for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Go back to the top.
